Permits - Permit# L 22-19 - 4434 West Arm Road - 6/28/2022 CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Permit# L 2�-f14
Date Issued: � Receipt t!
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quant4 DESCRIPTION OF WORK FEES Subrrcui
. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $40.00 per y0.�o
Additional Inspection trips for Rei nspection/Bond ing/Equ i potential Plane/etc. $40.00 per
B. RESIDENTIAL One and Two-family dwelling units Up to 3 trips included in fee
1. New Dwelling Unit up to and including a 200 amp service $ 125.00 per unit
2. New Dwelling Unit, 201 amp to 400 amp service $ 175.00 per unit
3. Existing Dwelling Unit, additions,alterations, or repairs up to& including a 200 amp service,
fees as per C & D below but not to exceed $ 125.00 per unit
4. Existing Dwelling Unit, additions, alterations, or repairs 201 amp to 400 amp service
fees as per C &D below but not to exceed 175.00 per unit
5. New or Existing Dwelling Unit, 401 amp service or above See C& D below
C. FEES FOR NEW OR UPGRADED SERVICES,TEMP. SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP. STRUCTURES
1. Up to and including a 200 amp service $ 50.00 each 610,00
2. 201 amp to and including 400 amp service $ 100.00 each
3. 401 amp to and including 800 amp service $200.00 each
4. 801 amp service and above $300.00 each
D. FEES FOR CIRCUITS/FEEDERS&TRANSFORMERS
0 to 200 am $ 10.00 per circuit I o.,00
Above 200 am $ 15.00 per circuit
Transformers up to 10 KVA $ 20.00 each
Transformers over 10 KVA $ 30.00 each
E. MULTI-FAMILY DWELLINGS
Each dwelling unit $50.00 per unit
. ALARM, COMMUNICATION, SIGNALING CIRCUITS,OF LESS THAN 60 VOLTS
Each System Device or Apparatus @ $ .50 each
.WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge.0006 of the permit fee(minimum of$1.00) 1.00
TOTAL AMOUNT DUE
Do not forget State Surchar a Fee
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: Tre' 4" /lr L 4 L-d� t-4
Separate Permits are required for any building, mechanical, fire,or plumbing work.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address:
NK 3' Ww�_ 2�� Sr,rina Park MN _Zip: SS�•�/
OR Legal Description: Lot:
Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Or Owner: O
Contractor/Company Name:
L�. S+� License#: 7 y
Address:
S0 1 klej�d f , 1� . City/State: M!(/. Zip:
Telephone: Office/Home: -7 Mobile: ( 1 Z ) 7 - t7
E-mail: �sn �rt�cc{�%r,� Srv•w�� Fax:
Builder/Owner Name: Q j e k i
Address(if diff. from Site): City/State: Zip:
Telephone: Office/Home: (_) - Mobile: (_J -
E-mail: Fax' (_} -
I HEREBY APPLY FOR AN ELECTRICAL PERMIT,AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE;I
UNDERSTAND WORT{IS NOT TO START WITHOUT A PERMIT. I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE
PERMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO IIE FOLLOWING:(1)THE CONDITIONS OF THE PERMIT,(2)THE APPROVED
PLANS AND SPECIFICATIONS,IF NEEDED(3)THE APPLICABLE CITY APPROVALS,ORDINANCES,AND CODES,AND(4)THE STATE
BUILDING/ELECTRICAL CODE. I UNDERSTAND THAT THE PERMIT WILL EXPIRE,AND BECOME NULL AND VOID IF WORK IS NOT
COMPLETED WITHIN 12 MO D][S F VALIDATED
DATE
WITH HF1 HATEMRESPONSIBLE
FORBUILDING/ELECTRICAL CODING THAT ALL REQUIRED
INSPECTIONS ARE REQ /
Signature: Date: 6
PAYMENT MUST ACCOMPANY APPLICATION(Be sure to include State Surcharee in payment)
o Check attached—Check# MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect-com
FAX: 952-442-7521
MAIL/DELIVER:MNSPECT,235 West First Street Waconia,MN 55387
Visa/Master Card— $
Account Number Expiration Date I CSV Amount to be withdrawn
Credit Card Owner Billing Address: ! me S�S� b� AV`' - m ov, SS 3 -
Street Address City,Staee Zip Code
_ I
Payment Authorization Signature(REQUIRED) Print Name on credit card(REQUIRED)
r �
M NS�PE�CT� LLC Sales Receipt
�.
Date Sale No.
952-442-7520 Fax 952-442-7521 888-446-1801
6/17/2022 7661
Sold To
Lake State Electric
Payment Method Check No.
Visa
Description Qty Rate Amount
Electrical Inspection/Permit Fee-L22-19-4434 West Arm Rd 100.00 100.00
State Surcharge-Electrical 1.00 1.00
Total $101.00